Sleep and Wellness: Learning to Cherish your Sleep
By Jack Ringler, MD
In a 1949 Irwin Shaw story, “The Climate of Insomnia,” a sleepless professor quips: “Sleep is the first great natural resource to be exhausted by modern man.” The modern world does hinder our ability to sleep naturally. We sleep less well than our great-grandparents. What are the consequences of sleep debt? What can we do about it?
Caring for patients with sleep disorders for 25 years has nurtured my wonder about the relationship of sleep and health. In one way, the relationship is simple and bi-directional: If one sleeps well, one feels well; and if one feels well, one sleeps well. In many other ways, however, we are humbled by how little we know about how sleep serves health.
Recent research has emphasized how important adequate sleep is to physical and mental wellbeing. Widely quoted studies stress the relationship between sleep duration and life expectancy. Published guidelines tell us how much sleep we need to get. But the relationship between sleep and wellness is not simple. While the association of poor sleep and poor health is irrefutable, it is too often assumed to be a cause/effect relationship, whereby poor sleep causes disease. The unproven inference is that artificially increasing or decreasing sleep extends and improves life.
This may be true in some circumstances. Patients with crippling sleepiness from sleep deprivation or sleep apnea are at greater risk of accidents, and that risk can be reduced by correcting the sleep disorder. More frequently, however, a broader dysfunction causes both poor sleep and disease. The disturbed sleep of a patient whose “fight or flight” response is overdriven by a hyperactive thyroid gland, an anxiety disorder, or cocaine, is best understood as an innocent bystander of the medical condition.
Blind correction of under-sleeping or oversleeping without investigation is comparable to artificially feeding a patient who has lost her appetite without investigating the underlying cause. For example, feeding a patient with a bowel obstruction would be harmful. Similarly, the widespread use of sedative or stimulant medications to achieve a standard benchmark number of sleep hours may not be healthy. Studies of long-term use of sedative medications have yielded mixed results. Hours of sleep do increase, but any associated benefit may be offset by side effects including falls and memory deficit. As might be predicted, medical attention to a third of our lives needs to be embraced as complex. After 25 years, I find myself disinclined to pursue the siren song of simple solutions.
A patient once confided: “At our first session, I was convinced that my sleep had betrayed me. I have since learned that I betrayed my sleep.” This remarkably self-insightful breakthrough highlights the limitations of guidelines and benchmarks. Patients suffer uniquely. Sleep problems, more than any other problems I encounter, require an intensely personal approach. For many complex reasons, contemporary clinical medicine too often tends to lump patients into diagnostic silos. Medical interviews and notes are electronic templates; patients and providers are literally separated by computer screens. It becomes easy to forget that there is no substitute for a literal, compassionate, individualized approach to care.
I advise my students to read an essay by F.W. Peabody that closes, “… the secret of the care of the patient is caring for the patient.” I advise my patients with sleep disorders that the secret to better sleep is cherishing your sleep. Sometimes that means paying more attention to it and recognizing its value for the first time. Sometimes it means less scrutiny because focusing too much on insomnia makes it worse. Occasionally, patients must forgive their sleep in order to heal it. Always, it means embarking on an adventure comprised of more questions than answers, exploring in a personal hopeful way how one’s life may be enriched, as mine has been, by a sense of wonder about sleep. Pleasant dreams.
A pulmonologist/critical care, and sleep medicine physician, Dr. Ringler is the Medical Director of the BMC Sleep Disorders Center.